Making a Diagnosis of Autism Spectrum Disorder - A Closer Look

What do you think about Billy’s behavior in your office?

Clings to Mother
A girl hugging her caregiver

Does the fact that Billy clings to his mother exclude a diagnosis of autism spectrum disorder (ASD)?

  • It is sometimes thought that children with ASD do not show any emotions or have attachments with caregivers. While this may sometimes be true, many children with ASD do have relationships with others. However, there are qualitative impairments in these social interactions.
Points to Ball
A little boy playing with a ball

Billy pointed to a ball. Does the fact that he pointed mean he does not have ASD?

  • Billy did point to the ball as he named it. However, there was no joint attention involved with the point. He did not look at his mother to see her response as he referenced the ball.
Brief Eye Contact
A young boy in a jacket looking away

Billy makes brief eye contact with you. Does this make a diagnosis of ASD more or less likely?

  • Children with ASD may not have a complete lack of a particular skill. Making brief eye contact only once during the entire office visit would be considered marked impairment.

What next steps should be taken?

Parental and Physician Concerns

In this case, there were both parental and physician concerns.

  • Provide parental education
  • Simultaneously refer for:
    • Comprehensive ASD evaluation
    • Early intervention/early childhood education services if not already enrolled
    • Audiologic evaluation
  • Schedule a follow-up visit
Red Flags for Further Assessment

What “red flags” indicate immediate need for further assessment? (Practice Parameter from the American Academy of Neurology)

  • No babbling or pointing or other gesture by 12 months
  • No single words by 16 months
  • No two-word spontaneous (not echolalic) phrases by 24 months
  • Loss of language or social skills at any age

Note: Billy is older. However, it might be helpful to ask about these when taking his developmental history.


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